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Arizona Victim Thought Dead, Not


CBEMT

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I don't think you need an EKG to "prove" death. It is an MCI, multiple patients, the last thing I'm thinking about dragging around the highway is the LP-12. Its pretty simple. If he isn't breathing, even after you open his airway, he is dead. If you get more resources on scene, sending someone to double check probably isn't a bad idea, I really don't see where EKG evidence has any role in a multi patient trauma senario. Its likely that the patient in question WAS breathing, it just went unoticed. I suppose a monitor might have revealed a rhythm that might have prompted the provider to take a closer look, but honestly, this is a training/education issue, not something that should require a piece of technology to decide, IMHO.

Unless it's an obvious DOA-decomposition, decapitation, lividity/rigor, etc, our protocol says you must use a monitor to confirm DOA. As for multiple victims in a trauma situation, then obviously impending death is treated as a black. Clearly, if you are the only crew on scene, and the next available units are nowhere close, then 2 critical patients could overwhelm your resources. Point is, everyone's situation is different, and your actions depend on your specific resources. I am in a high volume urban area with plenty of resources available in all but the largest incidents, and I have never left a "nearly dead" patient(ie agonal resps) without attempting treatment. Futile most of the time- yes, but that is our protocol. If they show signs of life, they are worked.

Obviously, in a trauma scenario, a cardiac rythm is not the first thing you worry about, but if you want to confirm DOA, that is the only way to prevent pronouncing someone who is not yet deceased.

Do I hook up every traumatic arrest? Only if I am working them up and transporting.

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but honestly, this is a training/education issue, not something that should require a piece of technology to decide, IMHO.

I think its safe to say that BEMS' style of education, training, and clinical exposure are pretty rare among EMS systems in general. If you guys say he's dead, I'm comfortable saying he's dead.

Random City Fire Department.... maybe not.

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